12 Changes That Will Affect Doctors' Income in 2015

Leigh Page

Disclosures

November 25, 2014

In This Article

4. ACOs Enter a Crucial Year

When Medicare accountable care organizations (ACOs) mark their third anniversary in 2015, they will be at a critical juncture. The program's 3-year shared-savings contracts, which shielded ACOs from losing money, will start running out. ACOs that stay in the program will have to start taking on "downside risk," facing the possibility of big financial penalties.

Two announcements this year by the Centers for Medicare & Medicaid Services (CMS) suggest this transition won't be easy. CMS announced that only one quarter of ACOs received a shared-savings bonus, which shows how hard it is still to any make money in the program. And CMS also announced more departures from the Pioneer ACO program, where downside risk is already a reality and the stakes are much higher.

Although the number of shared-savings ACOs keeps rising, from 27 in 2012 to 337 this year, the number of Pioneer ACOs has fallen from 32 in 2012 to 19 this year. The drop in Pioneer ACOs is significant, because the shared-savings ACOs are supposed to end up looking like the Pioneer ACOs, said David Muhlestein, PhD, director of research at Leavitt Partners, a Salt Lake City healthcare intelligence firm that tracks ACOs.

"The worst that can happen to a shared-savings ACO is not getting a bonus, but Pioneer ACOs are on the hook for a penalty if they don't meet certain targets," Muhlestein said. He said CMS is under pressure to extend the shared savings model and may decide to do so next year. If CMS lets the current timetable stand, he said, a lot of shared-savings ACOs might drop out, and worse yet, many more organizations sitting on the sidelines might lose interest in the ACO program.

As more Medicare ACOs are created, independent physicians will have to decide whether to join them. One challenge is the added paperwork—doctors will need to report 33 mandatory quality measures—and another is the lack of shared-savings payouts. In a 2013 survey[6] of ACO physicians, only 14% reported a getting financial benefit.

But Muhlestein said physicians deciding whether to join ACOs shouldn't be focusing on the money. With time, he said, ACOs may start producing substantial shared savings, but not yet. "Participation wouldn't be worthwhile for doctors solely driven by financial interests," he said. "But it is worthwhile for physicians who believe this is a better way to practice medicine, or those who want to get some experience [in dealing with new payment method]."

5. Telemedicine Companies Cause Concern

If you haven't yet had patients who are using telemedicine companies, you may start noticing them in 2015. These services, which offer patients web- and telephone-based consultations with doctors whom they have never met, have been growing by leaps and bounds. The three largest companies—Teladoc, MDLIVE, and American Well—more than doubled their volume from 2011 to 2013 and continue to grow, according to the American Telemedicine Association.

But as these companies emerge onto the healthcare scene, they have been raising a great many concerns. Greg Billings, executive director of the Center for Telehealth and e-Health Law, said doctors working for the telemedicine companies have no familiarity with their patients and cannot directly examine them. They try to make up for this by asking patients to take pictures of themselves and, in some cases, even palpate themselves. But even with a simple condition such as a sore throat, the only way to know whether the patient has strep throat is to take a culture of the throat, which can't be done via video, he said.

This year, the Federation of State Medical Boards, which represents state licensing boards, issued model regulations[7] for telemedicine companies. These regulation would require telemedicine companies to establish an appropriate doctor/patient relationship and be able to confer via video rather than just telephone or email.

Telemedicine companies do seem to be taking patients away from physicians' practices. In a 2008 survey[8] of patients using Teladoc, 53% said they would have otherwise gone to a primary care provider (PCP). Patients are attracted to telemedicine because they can get immediate service without even leaving their homes, and it costs them less. A telemedicine session costs about $40-$50, and some employers even subsidize that amount. Health insurers, such as United Healthcare, WellPoint, Aetna, and Cigna, and some Blue Cross plans are now covering telemedicine.

Consumer groups don't seem alarmed about the trend. "It seems like a great convenience," said Carmen Balber, executive director of California-based Consumer Watchdog, adding that her only concern is that payers should not pressure people to use telemedicine when they want to see a doctor face to face.

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